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Encyclopedia > Prostatic hypertrophy
Benign prostatic hyperplasia
ICD-10 N40
ICD-9 600

Benign prostatic hyperplasia (BPH) also known as Benign prostatic hypertrophy or Benign enlargement of the prostate (BEP) refers to the increase in size of the prostate in middle-aged and elderly men. To be accurate, the process is one of hyperplasia rather than hypertrophy, but the nomenclature is often interchangeable, even amongst urologists. In BPH, the prostate grows larger and presses against the urethra and bladder, interfering with the normal flow of urine. It leads to symptoms of urinary hesitancy, frequent urination, increased risk of urinary tract infections and urinary retention. There is little correlation between BPH symptoms and the presence of prostate cancer. The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The C0 and C1 control code sets define control codes for use in text. ... Male Anatomy The prostate is an exocrine gland of the male mammalian reproductive system. ... Hyperplasia (or hypergenesis) is a general term for an increase in the number of the cells of an organ or tissue causing it to increase in size. ... Hypertrophy is the increase of the size of an organ. ... Female anatomy In anatomy, the urethra is a tube which connects the urinary bladder to the outside of the body. ... In the anatomy of mammals, the urinary bladder is the organ that collects urine excreted by the kidneys prior to disposal by urination. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... Urination, also called micturition, is the process of disposing urine from the urinary bladder through the urethra to the outside of the body. ... A urinary tract infection (UTI) is an infection of the urinary tract. ... Urinary retention is a lack of ability to urinate. ... Prostate cancer is a disease in which cancer develops in the prostate, a gland in the male reproductive system. ...

Contents


Symptoms

Urinary symptoms of hesitancy, sensation of incomplete voiding and frequently passing small amounts of urine are all suggestive of BPH in middle-aged and elderly men. Due to the incomplete voiding, there is stasis of bacteria in the bladder residue and an increased risk of urinary tract infections. Phyla/Divisions Actinobacteria Aquificae Bacteroidetes/Chlorobi Chlamydiae/Verrucomicrobia Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Nitrospirae Omnibacteria Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Bacteria (singular, bacterium) are a major group of living organisms. ... A urinary tract infection (UTI) is an infection of the urinary tract. ...


A small proportion presents with urinary retention, in which inadequate amounts of urine are passed and the bladder distends greatly. Untreated, this leads to a decrease in renal function and hydronephrosis (obstructive uropathy). Urinary retention is a lack of ability to urinate. ... In medicine (nephrology) renal function is an indication of the state of the kidney and its role in physiology. ... Hydronephrosis is distention and dilation of the renal pelvis, usually caused by obstruction of the free flow of urine from the kidney. ...


Etiology

Androgens (testosterone and related hormones) are considered to play a permissive role in BPH by most experts. This means that androgens have to be present for BPH to occur, but do not necessarily directly cause the condition. This is supported by the fact that castrated boys do not develop BPH when they age, unlike intact men. Additionally, administering exogenous testosterone is not associated with a significant increase in the risk of BPH symptoms. Dihydrotestosterone (DHT), a metabolite of testosterone is a critical mediator of prostatic growth. DHT is synthesized in the prostate from circulating testosterone. Testosterone is a steroid hormone from the androgen group. ... Dihydrotestosterone (DHT) is a biologically active metabolite of the hormone testosterone, formed primarily in the prostate gland, testes, hair follicles, and adrenal glands by the enzyme 5α-reductase by means of reducing the Δ4,5 double-bond. ... Testosterone is a steroid hormone from the androgen group. ...


DHT is localized principally in the stromal cells. Once synthesized, DHT can act in an autocrine fashion on the stromal cells or in paracrine fashion by diffusing into nearby epithelial cells. In both of these cell types, DHT binds to nuclear androgen receptors and signals the transcription of growth factors that are mitogenic to the epithelial and stromal cells. The importance of DHT in causing nodular hyperplasia is supported by clinical observations in which an inhibitor of 5α-reductase is given to men with this condition. Therapy with 5α-reductase inhibitor markedly reduces the DHT content of the prostate and in turn reduces prostate volume and, in many cases, BPH symptoms. Autocrine signalling is a form of signalling in which the target cell is the secretory cell itself. ... Paracrine signalling is a form of signalling in which the target cell is close to the signal releasing cell, and the signal chemical is broken down too quickly to be carried to other parts of the body. ...


There is growing evidence that estrogens play a role in the etiology of BPH. This is based on the fact that BPH occurs when men generally have elevated estrogen levels and relatively reduced free testosterone levels, and when prostate tissue becomes more sensitive to estrogens and less responsive to DHT. Cells taken from the prostates of men who have BPH have been shown to grow in response to high estradiol levels with low androgens present.


On a microscopic level, BPH can be seen in the vast majority of men as they age (particularly over the age of 70 years) around the world. However, rates of clinically significant, symptomatic BPH vary dramatically depending on lifestyle. Men who lead a western lifestyle have a much higher incidence of symptomatic BPH than men who lead a traditional or rural lifestyle. This is confirmed by research in China showing that men in rural areas have very low rates of clinical BPH, while men living in cities adopting a western lifestyle have a skyrocketing incidence of this condition (though it is still below rates seen in the West).


Much work remains to be done to completely clarify the causes of BPH.


Diagnosis

Rectal examination (palpation of the prostate through the rectum) may reveal a markedly enlarged prostate. It is dependent on the skills of the doctor. A rectal examination or rectal exam is an internal examination of the rectum by a physician or other healthcare professional. ... The posterior aspect of the rectum exposed by removing the lower part of the sacrum and the coccyx. ...


Often, blood tests are performed to rule out prostatic malignancy: elevated prostate specific antigen (PSA) levels suggest prostate cancer. It has to be borne in mind that rectal examination can increase PSA levels in patients without malignancy. Blood tests are laboratory tests done on blood to gain an appreciation of disease states and the function of organs. ... Prostate specific antigen (PSA, also known as kallikrein III, seminin, semenogelase, γ-seminoprotein and P-30 antigen) is a protein manufactured almost exclusively by the prostate gland; PSA is produced for the ejaculate where it liquifies the semen and allows sperm to swim freely. ...


Ultrasound examination of the testicles, prostate and kidneys is often performed, again to rule out malignancy and hydronephrosis. Medical ultrasonography (sonography) is an ultrasound-based diagnostic imaging technique used to visualize muscles and internal organs, their size, structure and any pathological lesions, making them useful for scanning the organs. ...


Epidemiology

More than half of the men in the United States between the ages of 60 and 70 and as many as 90% between the ages of 70 and 90 have symptoms of BPH. For some men, the symptoms may be severe enough to require treatment.


Treatment

Alpha blockers1-adrenergic receptor antagonists) (such as doxazosin, prazosin and tamsulosin) and certain antiandrogens such as the 5α-reductase inhibitors (finasteride and dutasteride) are used, often together, in suppressing the symptoms. Alpha blockers (also called alpha-adrenergic blocking agents) constitute a variety of drugs which block alpha-adrenergic receptors in arteries and smooth muscles. ... The adrenergic receptors (or adrenoceptors) are a class of G-protein coupled receptors that is the target of catecholamines. ... Antagonists In medicine and biology, a receptor antagonist is a substance that inhibits the normal physiological function of a receptor. ... Doxazosin mesylate, a quinazoline compound sold by Pfizer under the brand name Cardura, is used to treat high blood pressure and benign prostatic hyperplasia. ... Prazosin, brand name Minipress®, is a medication used to treat high blood pressure (hypertension). ... Tamsulosin is the generic name for a medicine (usually sold as Flomax), which is commonly used as an alpha blocker, particularly to treat the syptoms of benign prostatic hypertrophy (BPH)—enlargement of the male prostate gland. ... An antiandrogen, or androgen antagonist, is any of a group of hormone antagonist compounds that are capable of preventing or inhibiting the biologic effects of androgens, male sex hormones, on normally responsive tissues in the body (see androgen insensitivity syndrome). ... 5α-reductase inhibitors (or 5-alpha-reductase inhibitors) are a group of drugs with antiandrogenic activity, used in the treatment of benign prostatic hyperplasia and androgenic (or androgenetic) alopecia. ... Finasteride (marketed as Proscar®, Propecia®, Fincar®, Finpecia®, Finax®, Finast®, Finara®, Prosteride®) is an antiandrogen which acts by inhibiting 5-alpha reductase, the enzyme that converts testosterone to dihydrotestosterone. ... Dutasteride inhibits the conversion of testosterone into dihydrotestosterone. ...


There is also extensive evidence of the efficacy of Serenoa repens (saw palmetto) fruit extracts in alleviating mild-to-moderate BPH symptoms. A systematic review of evidence found comparable efficacy to finasteride. (Wilt et al., 2002) Other herbal medicines that have solid research support in systematic reviews include beta-sitosterol from Hypoxis rooperi (African star grass) and Prunus africanum (pygeum) bark, while there is less substantial support for the efficacy of Cucurbita pepo (pumpkin) seed and Urtica dioica (stinging nettle) root. (Wilt et al., 2000) At least one double-blind trial has also supported the efficacy of rye flower pollen. (Buck, et al., 1990) Binomial name Serenoa repens Hooker Saw Palmetto, Serenoa repens, is the sole species currently classified in the genus Serenoa. ... Systematic reviews are named as the highest level of medical evidence, by evidence based medicine professionals. ... Finasteride (marketed as Proscar®, Propecia®, Fincar®, Finpecia®, Finax®, Finast®, Finara®, Prosteride®) is an antiandrogen which acts by inhibiting 5-alpha reductase, the enzyme that converts testosterone to dihydrotestosterone. ... Binomial name Urtica dioica L. The stinging nettle (Urtica dioica) is a herbaceous flowering plant native to Europe, Asia, northern Africa, and North America, and is the best known member of the nettle genus Urtica. ...


Sildenafil shows some symptomatic relief, suggesting a possible common etiology with erectile disfunction. (Brown 2005) Sildenafil citrate, sold under the names Viagra, Revatio and (in the Indian subcontinent) Caverta, is a drug used to treat male erectile dysfunction (impotence) and pulmonary arterial hypertension (PAH), developed by the pharmaceutical company Pfizer. ... Erectile dysfunction, also known as impotence, is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis for satisfactory sexual intercourse regardless of the capability of ejaculation. ...


If medical treatment fails, transurethral resection of prostate (TURP) surgery may need to be performed. This involves removing (part of) the prostate through the urethra. There are also a number of new methods for reducing the size of an enlarged prostate, some of which have not been around long enough to fully establish their safety or side effects. These include various methods to destroy or remove part of the excess tissue while trying to avoid damaging what's left. Transurethral electrovaporization of the prostate (TVP), laser TURP, visual laser ablation (VLAP), TransUrethral Microwave ThermoTherapy (TUMT),TransUrethral Needle Ablation (TUNA), ethanol injection, and others are studied as alternatives. Transurethral resection of prostate (TURP) is a urological operation. ... Female anatomy In anatomy, the urethra is a tube which connects the urinary bladder to the outside of the body. ...


Newer techniques involving lasers in urology have emerged in the last 5-10 years. Starting with the VLAP technique involving the ND:YAG laser with contact on the prostatic tissue. A similar technology called Photoselective Vaporization of the Prostate (PVP) with the GreenLight (KTP) laser have emerged very recently. This procedure involves a high powered 80 Watt KTP laser with a 550 micrometre laser fiber inserted into the prostate. This fiber has an internal reflection with a 70 degree deflecting angle. It is used to vaporize the tissue to the prostatic capsule.


See also

Prostate cancer is a disease in which cancer develops in the prostate, a gland in the male reproductive system. ... Urinary retention is a lack of ability to urinate. ...

References

  • Brown AJ (Nov 21, 2005). Sildenafil Improves Urinary Symptoms in Men With Erectile Dysfunction. Retrieved on February 8, 2006.
  • Buck AC, Cox R, Rees RWM, et al. (1990) Treatment of outflow tract obstruction due to benign prostatic hyperplasia with the pollen extract, Cernilton. A double-blind placebo-controlled study Br J Urol 66:398-404 (Medline abstract)
  • Kirby R, McConnell J, et al. (eds) (1996) Textbook of Benign Prostatic Hyperplasia (Oxford: Isis Medical Media) ISBN 1-899066-24-1
  • Wilt TJ, Ishani A, MacDonald R, (2002). Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev 2002 (3), CD001423. (Medline abstract)
  • Wilt TJ, Ishani A, Rutks I, MacDonald R (2000) Phytotherapy for benign prostatic hyperplasia Public Health Nutr 3(4A):459-72 (Medline abstract)
  • Yarnell E (2001) Naturopathic Urology and Men's Health (Wenatchee, WA: Healing Mountain Publishing) ISBN 0-9741178-3-8 [1]

February 8 is the 39th day of the year in the Gregorian Calendar. ... 2006 (MMVI) is a common year starting on Sunday of the Gregorian calendar. ... The Cochrane Library is a collection of databases in medicine and other healthcare specialties provided by the Cochrane Collaboration. ...

External links

  • High Island Health - offers a patented prostate massager as an alternative means of treating BPH

 
 

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